One thing distinguishes soccer from other sports: ball play exclusively with either the feet or the head. We love watching the dramatic leaps and sharp cracks that accompany a header, but one of the biggest risks of injury for youth players comes from heading the ball. Players can sustain head wounds and concussions, the latter being particularly serious for the youngest players. Over the past decade, sports in general and soccer specifically have put in place concussion protocols to help detect when a player might have suffered the injury and how to treat it. Guidelines dictate how to discover if a player has a concussion through various questions to and responses from the player, as well as evaluating symptoms such as black outs, memory loss, nausea, dizziness and vision problems. However, the attitude that a head injury is just part of the game has kept organizations, families and coaches from focusing on prevention. As we have become more aware of the long-term effects of concussive episodes, we have all realized that we may need to address how to reduce the risks.

On Nov. 9, the United States Soccer Federation (USSF), the FIFA-sanctioned organization that oversees most adult and youth soccer in America, issued a statement concerning a comprehensive player safety campaign that will be rolled out before year’s end. The main thrust of the statement was in response to the settlement of concussion litigation which had been filed against USSF and other U.S. Soccer entities in August 2014. The class action lawsuit did not seek monetary damages. Instead it sought to force soccer’s governing body to address the dangers of concussions and to institute policies to prevent that injury. USSF was careful to clarify that it had already begun a study into player safety long before the lawsuit was filed, but indicated that the specific portion related to concussion had been given priority. The USSF worked with medical experts, trainers and coaches to develop guidelines for player safety and educational materials to address detection, treatment, and prevention of common soccer injuries. These guidelines will not be mandatory because several local soccer organizations lack the power to require adherence, but they are highly recommended. This extends to US Youth Soccer, which will support and disseminate these guidelines to state associations and local clubs.

USSF first recommends that players under 10 don’t head the ball at all. The rationale for this recommendation is that young players don’t have the muscle development to give enough support from their necks to the head during a strike. The more the head wobbles when hitting the ball, the more the brain rattles around causing injury. Additionally kids lack the motor skill development to time and control strikes accurately often resulting in head to head contact, missing the ball altogether. Young players also have still developing brains which don’t have the resilience to withstand and recover from injury in soft tissue. Those areas not yet fully developed can be permanently damaged, which can happen even in mature brains, but bring more lasting results in young brains. Treating concussions in young players is also more difficult because getting them to completely rest isn’t usually possible. They also have trouble elucidating symptoms because they have less context in which to recognize serious concerns.

The second recommendation was that players 10-to-13 years old head balls only during games, never during practice. This allows them to act upon their impulses during a fast-paced game, but limits their heading to those few instances a season. Coaches can teach proper methods for heading the ball, but without the ball. The players can spend these years training their neck muscles to be strong enough to regularly practice headers. The years can also be spent learning about concussions, their symptoms, and treatment, so that players will be better prepared to recognize when they might have been injured.

The third recommendation was that substitution rules be changed for older players. Right now, they may follow the FIFA requirements of only three substitutions per game. Under the USSF guidelines, teams wouldn’t be charged a substitution if they pull a player out for possible head injury and replace him or her. If the player can immediately return to the game, he or she must come in for the player who substituted for them, who can return to the pool of eligible players for substitution. The hope is that these guidelines will help coaches not be put in the position of sacrificing a substitution and therefore being hesitant to pull a player out putting that player at risk. Likewise the hope is that players will be more open to being replaced to check out their heads rather than toughing it out.

Each of these recommendations will be requirements for the Youth National Team program and the Development Academy. However, when the Youth National Teams travel, they will be subject to the substitution rules of the country they visit. The fact that these recommendations were reported by every major newspaper and media outlet speaks to several factors. First, it shows that USSF has a top notch PR department. Second, it indicates how significantly soccer interest has increased in America making these stories significant enough for the six o’clock news. Third, it highlights the importance of understanding the dangers of concussion for our youth players. Despite the broad media exposure, parents should still be sure that our clubs and coaching staffs have seen these recommendations and then adopt them. Check your state youth soccer association to see if the recommendations are mentioned and accepted. We parents need to recognize the importance of instituting these guidelines at every level of youth soccer and be instrumental in demanding they be implemented in our club.

Even more safety recommendations will be coming from USSF, but these concussion guidelines were rolled out early in order to address the demands of the lawsuit. The most exciting aspect of the player safety program will be the education portion. USSF promises clearer concussion protocols as well as other sideline protocols for common injuries. Recently we have seen a rise in undetected internal injuries leading to further complications even death. Therefore coaching staffs need to understand how to test for internal bleeding which is relatively easy. Also USSF will hopefully look at repetitive motion injury and introduce guidelines for reducing these through rotating drills and proper stretching. I’m looking forward to seeing how extensive this campaign turns out to be. Optimistically, it will include online training videos, pamphlets, clear guidelines for reducing injury, and parental support. No matter how detailed the campaign turns out to be, the fact that the major American soccer oversight organization is addressing player safety is a step in the right direction. Developing safety standards that we can trust no matter where we move in the country gives all parents some peace of mind. You may want to follow the roll-out of the campaign on the USSF website (www.ussoccer.com) but remember that the site is primarily dedicated to announcements on the schedule and results of the various U.S. National Teams, so you may need to search a bit to discover what you want. The link on the upper bar for “stories” will take you to the various announcements the group is making. You can also get a head start on learning more about concussions by taking the free course offered by US Youth Soccer.

The lawsuit highlighted a serious health epidemic in youth soccer. In 2010 nearly 50,000 high school soccer players sustained concussions. This number eclipses the total number of players suffering concussions in baseball, softball, wrestling, and basketball combined. By asking for the establishment of guidelines and educational programs rather than a monetary award, the plaintiffs clearly placed the responsibility for these details on the primary soccer organizations in the United States. They are the ones with the resources for studying the problems, researching solutions, and distributing materials throughout the youth soccer community. As parents we have the responsibility of recognizing the various safety concerns for youth players, requiring that our clubs address those concerns, and then making use of all available research and standards to attain the best level of safety we can for our kids. As we become more aware of the possible injuries, we shouldn’t be alarmed, but we should be cautious and learn both the signs of and prevention for these injuries. Having an organization as encompassing as USSF take the lead in these factors means that we’ll have both a strong resource and an advocate in providing the safest environment we can for our children.

Comments

Thomas Kaminski, PhD in Newark, DE said:
Susan: Your description of this recommendation is inaccurate! The recommendation taken directly from US Soccer's "Recognize to Recover" document reads "U12 and U13 (11y - 13y) Heading training limited to maximum of 30 minutes per week with no more than 15-20 headers per player, per week" Perhaps you should make this correction to your blog audience. It will be interesting to see how the rule change plays out and as to whether or not it is enforced?
DR. K.

14 February 2016 at 1:57 PM

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